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Female Fertility Preservation for cancer treated patients

New advances in medicine usually bring with them hope. However, they also bring new risks. The history of medicine has demonstrated that with almost every new treatment, whether medical or surgical, new complications arise.

The most common cancers diagnosed in women under the age of 40 years are breast cancer, melanoma, cervical cancer, non-Hodgkin’s lymphoma, and leukemia.

An estimated 1,372,910 people were diagnosed with cancer in 2005, of which 4% (approximately 55,000) are under the age of 35.

The effect of chemotherapy and radiotherapy on future fertility is of concern to patients and their families. A common concern of female patients and their families is the effect of chemotherapy and radiotherapy on future fertility. It should be stressed that some cancer treatments result in 99% ovarian failure. Whereas menopausal symptoms and signs can be treated medically, no solution is available to preserve female gametes.

The enormous advances in oncology, haematology and bone marrow transplantation (BMT) have resulted in a 90% remission rate in various diseases.

Both male and female fertility preservation is a new modality of treatment for patients at the reproductive age undergoing cancer treatment. For the male patient sperm from semen collection and biopsies tissue banking is commonly performed, but for the female eggs are not so amenable to cryopreservation (freezing them to be used in the future). Fertility preservation method of treatment in female patients is used for cases that are treated for cancer such as Breast cancer or Lymphomas and leukemia diseases at reproductive age

At the present time, we recommend urgent IVF in most patients requesting fertility preservation. Ovarian cryopreservation should be offered when emergency IVF is not possible.

Fertility preservation options in females depend on the patient’s:

            - Age.

            - Type of treatment.

            - Diagnosis.

            - Whether she is married.

            - The time available and.

            - The potential that cancer has metastasized to her ovaries.

In the USA alone, >650 000 women will be af¯icted by cancer in 2003, and 8% of these cases will be aged <40 years. Due to improvements in cancer therapy, cure rates of both adult and childhood cancers increased significantly over the past three decades. However, long-term consequences of cancer therapy and impact on quality of life are now being recognized. One of the major sequelae of cytotoxic chemotherapy is gonadal failure. Cytotoxic chemotherapy and/or radiotherapy are not only used to treat malignant diseases, but also non-malignant systemic conditions.

Upon reviewing the extent and mechanism of gonadal damage due to chemo-/radiotherapy, this article discusses indications and the wide range of methods of fertility preservation in a comprehensive manner. All current, emerging, experimental as well as controversial approaches are reviewed. A comprehensive algorithm to manage fertility preservation through an individualized approach is presented.